APPLICATION

We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin,
age, disability, marital or veteran status, sexual orientation or any other legal protected status.
This employer requires a pre-employment physical and drug test.

Position(s) applied for: Date of Application: 01-05-2010

Any

How did you hear about us? (Ex: Ad, Friend, Walk-in) Friend

Last Name: Crandall First Name: Mathew Middle Initial: A.

Address: 645 Park Street North City: Grantsburg State: WI

Zip: 54840

Home Phone: None Cell/Pager Phone: 612-310-3085 Birth Date: 06-13-79

Social Security #: 474-02-1485 Endorsement: Citizen of

US? Yes

Drivers License Number: C653-5417-9213-04

If you are under the age of 18, can you provide Yes
proof of your eligibility to work?

Have you ever filed an application with us before? No

If so, give date:

Have you ever been employed with us before? No

If so, give date:

Are you currently employed? No

May we contact your present employer? Yes

Are you prevented from lawfully becoming employed No

in this country because of Visa or Immigration status?
Proof of citizenship or immigration status will be requested upon employment.

On what date would you be available for work? 01-06-10

Are you available for work: Full time

Are you currently on “lay-off” status and subject to recall? No

Can you travel if a job requires it? Yes

Have you been convicted of a felony within the last 7 years? No

EDUCATION

Name/Address of School Course of Study Years Completed Degree?

Elementary Mckinley Elementary General 6 years Yes
School Ham Lake, MN

High School Blaine High School General 4 years Yes

Blaine, MN

Undergraduate None
College

Graduate None
College

Other (Specify) None

Describe any specialized training, apprenticeships, skills or extra-curricular activities:

Some automotive classes for general automotives.

Describe any job-related training received in the United States Military:

None.

Describe any hobbies or activities that you enjoy doing:

Hunting, fishing, camping, riding four wheeler, and working on cars.

 Employment Experience
Begin with your present or last job. Please include any job- related military service assignments and volunteer activities.
1.
Employer: AMZ Automotive Dates Work Performed:
Employed:
Address: 308 South Lake Street Forest Lake, MN 55035 From: 10/09 Working on cars, wrote
estimates, inventory.
Phone Number: 615-982-6900 To:11/09

Job Title: Mechanic Hourly Rate:

Reason for Leaving: laid off due to lack of work Start:$15/hr

End:$15/hr
2.
Employer: Forest Lake BP/Fuhr Enterprises Dates Work Performed:
Employed:
Address: 1267 West Broadway Ave. Forest Lake, MN 55025 From:11/01 Working on cars, inventory,
fixed gas pumps, fixed
carwash, wrote and sold
estimates, posted invoices,
rented out budget trucks,
plowed lot with bobcat,
patched parking lot, filled
propane,
Phone Number: 651-464-7812 To:5/09

Job Title: Manager/Mechanic Hourly Rate:

Reason for Leaving: laid off Start: $8/hr

End:
38,000/yr
3.
Employer: Hertzberg Book Bindery Dates Work Performed:
Employed:
Address: Jacksonville, Illinois From: 2/01 cleaning

Phone Number: To: 9/01

Job Title: Janitor Hourly Rate:

Reason for Leaving: Moved Start: 7.50

End:
4.
Employer: Dates Work Performed:
Employed:
Address: From:

Phone Number: To:

Job Title: Hourly Rate:

Reason for Leaving: Start:

End:
Additional Information
Summarize special job-related skills and qualifications acquired from past employment or experience:

Specialized Skills
Check Skills/Equipment Operated:
Operators Laborers Drivers
 Paver  Gravel  Belly
 Superintendent  Roller
 Dozer  Bit  Tri-Axle
 Foreman  Blade
 Loader  Raker  Tandems
 Mechanic  Skid
 Broom  Jackhammer  Distributor
 Truck  Mill
Dispatcher  Excavator  Manhole  Transport

Please state any additional information you feel may be helpful to us in considering your
application:

References

Give the names of three persons NOT related to you, whom you have worked with at least one year:

1. Mark Zaver 612-210-5673

(Name) (Phone Number)
Ham Lake, MN 55304
(Address)
References Continued…

2. Karlen Walstad 612-518-4370

(Name) (Phone Number)
Andover, MN
(Address)

3. Max Gorkiewicz 715-338-7346

(Name) (Phone Number)
Grantsburg, WI 54840
(Address)

Applicant Statement
I certify that answers given herein are true and complete to the best of my knowledge.

I authorize investigation of all statements contained in this application for employment, as may be necessary in arriving at
an employment decision.

I hereby understand and acknowledge that unless otherwise defined by applicable law, any relationship with this
organization is of an “at will” nature, which means that the employee may resign at any time and the employer may
discharge employee at any time or without cause. It is further understood that this “at will” employment relationship
may not be charged by any written document or by conduct unless charge is specifically acknowledged in writing by an
authorized executive of this organization.

In the event of employment, I understand that false or misleading information given in my application or interviews may
result in discharge, I understand, also, that I am required to abide by all rules and regulations of the employer.

I understand that if I am made an offer of employment, it may be contingent upon my providing a medical history and
passing a physical evaluation, including a drug and alcohol screening at my expense. (Reimbursements after 30 days of
employment).

Mathew Crandall 01-05-10

Signature of Applicant Date

For Department Use Only

Arrange Interview- Yes No
Remarks:

Date of Employment: Job Title:

Hourly/ Salary Pay:
Notes:
 HIRING POLICY
It is the policy of Valley Paving, Inc. to accept applications for employment from individuals
directly, or through a job service office of our choosing or that is a representative of our company.
Valley Paving will not accept applications that have been completed and signed by anyone other
than the individual applying for the position.

It is the policy of Valley Paving to provide equal employment opportunity to all individuals and not
discriminate on the basis of race, color, religion, sex, national origin, age, alliance, marital or
familial status or any other classification which is protected by law. It is the intent of Valley Paving
to be in compliance with all federal and local laws with regards to its hiring policy.

No job site applications or hiring shall be permitted. This would cause safety hazards and
unauthorized personal on the job site.

Valley Paving will hire employees only when its needs and circumstances dictate. Any applicant
must complete an application provided by the company. Valley Paving will not accept applications
on forms other than which our company provides.

If Valley Paving receives an application for employment during a time period when we are not
hiring, we will maintain that application on file for 30 days from the date of the application. Such
filings do not guarantee that an application will be considered at a future date. This is done not to
discriminate against any person or individual, but it is merely a reflection of the needs and
circumstance, which may dictate the company’s action at that time.

Valley Paving reserves the right to evaluate all applicant’s physical fitness for positions based on
relevant criteria, including minimum or maximum experience and education, appropriate wage or
salary history for the position sought, willingness to perform all duties assigned, skill levels,
attitudes, demeanor, and all other criteria deemed relevant by Valley Paving’s sole discretion.

Valley Paving reserves the right to assess prior work experience and skill levels, and confirm
applicants work references, driver’s license for positions requiring driving, and education and
licensure where applicable, and will require applicants to authorize and hold Valley Paving
harmless with respect to any such inquiries of former employers.

Valley Paving requires that applicants and employees provide truthful responses to all
employment-related inquiries, both written and verbal, and reserves the right to reject any
applicant and terminate any employee for providing false or misleading employment-related
information, or omitting relevant information, no matter when these violations are discovered.
Failure to provide complete and accurate responses to all questions, without material omission, will
disqualify applicants from consideration for employment with Valley Paving.
Mathew Crandall 01-05-10
Signed Date